Vocal cord surgery is a general name for many different types of
procedures that can be performed on the vocal cords.
What are the indications for vocal cord surgery?
Vocal Cord surgery is performed when the vocal cords have growths,
such
as, polyps, tumors, or other masses that need to be removed for
biopsy or to improve function. The child will usually exhibit a
hoarse or raspy voice.
Vocal Cord surgery is also indicated to normalize vocal cord
functioning when the vocal cords are scarred from various causes,
paralyzed, or are otherwise abnormal. These conditions may
interfere with the complete opening and/or closing of the vocal
cords, which is necessary for normal speech and breathing.
How is vocal cord surgery performed?
Surgery on the vocal cords can be performed either directly in an
open surgical approach (making an incision in the neck) or
indirectly through an endoscopic approach (through a tube inserted
into the mouth and throat).
Either procedure is performed under general anesthesia (the
patient is fully asleep).
An open surgical approach is most often performed after trauma or
fracture of the larynx (upper front of neck) has occurred. Please
see REPAIR OF FACIAL AND NECK TRAUMATIC INJURIES in "Surgeries We
Perform".
Although the open surgical approach allows somewhat better control
of the vocal cords during the procedure, the endoscopic approach
may be more successful in restoring more normal voice sound. The
endoscopic approach also has the advantage of allowing extremely
close observation of the vocal cords, therefore resulting in a
precise and accurate cut or removal of tissue. However, not all
surgeries can be performed endoscopically. Be sure to discuss this
option with your doctor.
Recovery after either an open or endoscopic approach includes
minimizing damage to the larynx during surgery, as well as
reducing inflammation after the surgery. Therefore, your surgeon
will recommend the procedure he/she feels will minimize these
complications.
What is involved with endoscopic vocal cord surgery?
Endoscopic vocal cord surgery is basically MICROLARYNGOSCOPY
(magnified examination of the vocal cords) in addition to a
corrective procedure performed on the vocal cords.
As mentioned above, this surgery is performed with the patient
under general anesthesia (fully asleep). The patient is lying on
the back and a laryngoscope is inserted in the mouth to hold down
the tongue and visualize the vocal cords. A special telescope or
operating microscope is used to get very close and detailed views
of the vocal cords and surrounding areas.
There are many different methods used to correct vocal cord
abnormalities. These can include using forceps (like tweezers) to
hold a bump or nodule and small scissors or the CO2 laser (see
below) may be used to remove it. Powered instruments may also be
used to remove lesions. These rotating blades remove growths such
as papillomas with very little damage to normal tissue.
Defects on the vocal cords or surrounding areas may be repaired by
injections, flaps of tissue, or grafts depending on the size of
the defect.
The surgery itself usually lasts about an hour, but is highly
variable. Removal of nodules or bumps or more simple
reconstructive procedures may not require an overnight stay in the
hospital. More complex procedures may require a hospital stay.
What is the CO2 laser?
Laser stands for "light amplification by stimulated emission of
radiation". The CO2 laser device increases the intensity of light
waves using CO2 (carbon dioxide) and concentrates them in an
intense, penetrating beam of light. This is similar in a way to
using a magnifying glass to concentrate the sun's rays; the
"concentrated" sun rays underneath the magnifying glass get hot
enough to burn paper for example. Similarly, the CO2 laser beam
can be used to very accurately "burn off" areas of tissue that
need to be removed, (vaporized).
Why is the CO2 laser used in vocal cord surgery?
The CO2 laser can be passed through the glass of the operating
microscope, allowing for very accurate placement of the laser beam
on the vocal cords. This method of tissue removal is much more
precise than surgical scissors, and results in less bleeding and
inflammation to the surrounding tissues. As mentioned previously,
the less traumatic the surgical procedure, the more favorable the
outcome, including faster recovery.
What are the risks of using the CO2 laser?
Although the laser can precisely vaporize the desired tissue, it
can also accidentally burn basically anything else it may come in
contact with. Therefore, safety precautions have been made to
avoid this complication. These safety precautions include
protective eye gear for both the patient and the operating team. A
wet cloth may also be placed over the patient's face and eyes.
Also, as the breathing tube can catch on fire, these surgeries are
usually performed without a breathing tube in place while the
laser is in use. In addition, the lowest amount of oxygen needed
is used during the procedure.
What are the risks and complications of vocal cord surgery?
The risks with the use of the CO2 laser are described above. The
short-term risks of vocal cord surgery in general include chipped
teeth (protective teeth guards are used during surgery to help
prevent this), bleeding, breathing difficulties, hoarseness,
change in voice quality, or infection.
Long term risks include a less than desired outcome in regaining
normal voice or scarring from the surgery that may need additional
surgical repair in the future.
Your surgeon will discuss these with you in detail.
What is involved with recovery after vocal cord surgery?
Recovery after vocal cord surgery is dependent on the surgical
procedure, as well as how well inflammation and swelling are
controlled after the surgery. Your surgeon will give you
guidelines on how to start reusing your voice. It is important to
follow to these guidelines and keep all recommended follow up
appointments to regain optimal vocal cord function.
uch
as, polyps, tumors, or other masses that need to be removed for
biopsy or to improve function. The child will usually exhibit a
hoarse or raspy voice. 